Yogurt a solution to hospital infection?

PHILADELPHIA — In a medical system rife with complex equipment and outrageously expensive drugs, a Pennsylvania hospital has turned to a cheap, low-tech solution for one of modern medicine’s most challenging problems.

Holy Redeemer in Montgomery County, Pa., is using yogurt — the kind you could buy at the grocery store — to fight C. difficile, a hospital-acquired infection that has been growing throughout the country.

After dietitians began encouraging patients taking antibiotics to eat yogurt, the infection rate fell by two-thirds. Holy Redeemer has now expanded the program to its nursing-home residents.

“We were really surprised by how easy it was and how quick it worked,” said Jeanie Ryan, a registered dietitian who helped coordinate the effort. “It was just so sudden and such a big impact that it was striking.”

The Hospital & Health system Association of Pennsylvania earlier this year gave Holy Redeemer an Innovation Award for the program.

Other hospitals remain skeptical. Thomas Jefferson University Hospital uses probiotics, or beneficial yeast and bacteria, in pill form only in clinically stable patients who must take antibiotics for long periods.

Neil Fishman, associate chief medical officer at the University of Pennsylvania Health System, said there was not enough science to support the wide use of yogurt or probiotics. They can be dangerous in patients with compromised immune systems.

He said the bacteria in yogurt were not native to the human digestive system and thus would not perform like the normal flora devastated by antibiotics.

Fishman wondered whether other measures helped reduce infection rates at Holy Redeemer. “I doubt strongly that a two-thirds reduction is just due to eating yogurt,” said Fishman, who advises the Centers for Disease Control and Prevention on infection control. And “I love yogurt,” he said.

The most effective way to reduce C. diff, he said, is to prescribe antibiotics more carefully.

Barbara L’Amoreaux, a Holy Redeemer spokeswoman, said there were no other changes in patient care in the year before the hospital asked patients to eat yogurt.

In 2011, Holy Redeemer officials became alarmed by the increasing numbers of hospital-acquired C. difficile cases. The bacteria cause severe diarrhea and can be fatal. Holy Redeemer had 75 hospital-acquired cases in 2011.

The bug is particularly hard to kill on surfaces, and the infection rate did not improve despite isolation of infected patients, education of the staff, and a change in disinfectants. The CDC says hospital cases nationwide have tripled in the past decade to nearly 337,000. Most C. difficile cases are related to medical care, but only about a quarter show symptoms first in the hospital, the CDC says. C. diff infections cost at least $1 billion annually in extra health-care costs.

At an infection-control committee meeting at Holy Redeemer, a surgeon suggested using probiotics against the bug. While antibiotics are essential for fighting infections, they also can throw off the delicate balance of bacteria in our bodies by weakening both good and bad microorganisms. Without the good bugs to keep it at bay, C. difficile can take off and make us sick.

Ryan and fellow dietitian Anne Kathryn Bromm knew that some hospitals were using probiotics in granular form, but they liked the idea of giving a food. Yogurt is popular, and it has the extra benefit of providing protein, vitamins, and energy.

After comparing many brands, they decided there was no good reason to pick one over another. The one they were already using — Dannon — contained three types of beneficial bacteria: S. thermophilius, L. bulgaricus, and L. acidophilus. They decided to start with it, expecting that they might need to switch later to others.

The idea has been “extremely well-received,” Bromm said. “They have a good understanding of yogurt and probiotics.”

BY THE NUMBERS

337,000: Number of cases of C. difficile each year at U.S. hospitals, a threefold increase over the last decade.